Expert Panel Calls for Collective Accountability

According to the expert panel, health providers should ‘collectively be held accountable – under a shared leadership model – for achieving a set of pre-agreed quality outcomes within a given budget or expenditure target’.

After an onslaught of speculation and continued delay, the recommendations, ‘Systems, not Structures: Remodelling Health and Social Care’, drawn up on the reconfiguration of the health service, have finally been released into the public domain.

The running theme throughout the document – and set to replace the ‘outdated contract models’ – in the implementation of Integrated Accountable Care Systems, which would allow providers more autonomy and empowerment.

However, not all services would be incorporated in this model due to their specialist nature – a select number would be subject to a different commissioning standard at a regional level. Specialist services will also be rationalised in order to free up resources and invest in new delivery models.

The remainder of the panel’s recommendations – headed up by Professor Rafael Bengoa – strike a familiar chord, reiterating the necessary drive towards ‘a more personalised, preventative, participative, and predictive model of care.’

ICPs and GP federations must be ‘fully enabled with devolved autonomy and incentivising funding mechanisms’, a renewed emphasis on e-health is advised, and a platform for a more open and immediate conversation with staff and service users should be considered.

The inspiration for the region’s suggested service redesign is the Triple Aim framework. Developed by the Institute for Healthcare Improvement, the guidance outlines that services must simultaneously pursue three dimensions:

Improve the patient experience of care

Improving the health of populations

Reduce the per capita cost of healthcare

‘The stark options facing the HSC system are either to resist change and see services deteriorate to the point of collapse over time, or to embrace transformation,’ the panel has warned.

As a result, the time frame for the implementation of actions ‘should be prepared within the next 12 months’, overseen by a transformation board.

Published alongside the proposals, and offering a more telling insight into the long-term provision of services and implementation of changes is Health Minister, Michelle O’Neill’s, vision which you can also now read online here.